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No-Cost Preventative Services Recommended for Women

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The U.S. Department of Health and Human Services (HHS) should require that new health insurance plans cover a larger percentage of women's preventative health services under the federal health reform law without requiring consumers to pay additional out-of-pocket costs, an Institute of Medicine (IOM) panel said in guidelines released July 19, 2011.

The panel also made a number of other recommendations for comprehensive guidelines that “are important to women’s health and well-being,” according to the non-profit health policy group. If accepted, women stand to substantially benefit from added preventative health services.

Last year, HHS Secretary Kathleen Sebelius asked the independent panel to examine what constitutes a "preventive service" for women as part of a provision in the Patient Protection and Affordable Care Act (ACA) of 2010 that requires health plans to cover such services without co-payments or deductibles.

Sebelius said the department is examining the panel's recommendations "closely" and will make a final decision "very soon," reported Politico.

Sebelius could issue the final regulations by August 1, 2011. The New York Times reported that the Obama administration has said it is inclined to adopt the panel's recommendations, which could take effect for many plans in early 2013.

The IOM defined preventive health services as measures—including medications, procedures, devices, tests, education and counseling—shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition.

The IOM recommends the women’s preventive services covered by private health care insurance with no out-of-pocket cost to the patient covered should include:

  • improved screening for cervical cancer, counseling for sexually transmitted infections, and counseling and screening for HIV;
  • a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes;

  • services for pregnant women including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully;
  • at least one well-woman preventive care visit annually for women to receive comprehensive services; and
  • screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner.
  • Among their guidelines, IOM has recommended that the cost of HPV co-testing should be covered by private insurance without co-pay for women age 30 and older and be performed at the same time, and with the same cervical cell sample as a Pap test, to help “fill the gap” of women’s health care.

    The panel said the human papillomavirus (HPV) test is an essential preventative health care service because it can “identify the presence of high-risk HPV infections that can cause cervical cancer, enabling diagnosis and treatment before cervical disease or cancer can develop.”

    While the vast majority of insurances nationwide currently cover HPV
    testing, under current health care plans women must pay a co-pay or apply
    the cost towards their deductible.

    IOM says removing patient cost sharing for HPV testing puts the more sophisticated diagnostic screening technology on reimbursement parity with the Pap tests as an accessible cervical cancer screening tool without worry about out-of-pocket costs. This is an important factor given many socioeconomic, geographic and cultural disparities in cervical cancer cases highlighted in reports from the National Cancer Institute (NCI).

    Cervical cancer is one of the world’s most preventable cancers because
    its cause—HPV—is known and there are tests to detect HPV as well as
    vaccines to prevent exposure to the most common high-risk types. Yet
    there are an estimated 12,200 new cases of cervical cancer diagnosed annually in the U.S., and the disease takes the life of 4,210 American women each year, according to the NCI. Effective cervical cancer screening remains a key component of women’s preventative healthcare.

    “The inclusion of evidence-based screenings, counseling and procedures that address women’s greater need for services over the course of a lifetime may have a profound impact for individuals and the nation as a whole,” the panel said.

    Lynette Summerill is an award-winning writer who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.

    Sources: Institute of Medicine. Consensus Report. Clinical Preventive Services for Women: Closing the Gaps. July 19, 2011. Accessed at: http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx

    Politico. Kate Nocera. Institute of Medicine report: Insurers should cover birth control as preventive care. 7/19/11. http://www.politico.com/news/stories/0711/59388.html

    New York Times. Robert Pear. Panel Recommends Coverage for Contraception. 7/19/2011. http://www.nytimes.com/2011/07/20/health/policy/20health.html

    National Cancer Institute. Cervical Cancer Fact Sheet. Accessed at: http://www.cancer.gov/cancertopics/types/cervical

    Reviewed July 21, 2011
    by Michele Blacksberg R.N.
    Edited by Shannon Koehle

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